In our last post we introduced you to a potentially devastating foot complication related to diabetes, Charcot. (Read the first post in this series here). The outcome of this condition improves if caught and treated early. However, it is difficult to catch this condition in its early stage, especially for many primary care doctors.
In a survey of over 400 primary care physicians, 68% reported having a poor knowledge of this condition. It is no surprise then that one in every four cases of Charcot is diagnosed incorrectly. Primary care physicians most often think that early Charcot is an infection, gout, a sprain or a deep blood clot in the leg. Given this tendency to diagnosis the condition incorrectly, the average delay in receiving the correct treatment is around 7 months.
During this time the bones of the foot shift and collapse, creating rigid deformities of the foot that result in callus formation. These calluses quickly turn into a wound which can become infected. Having these deformities of the foot increases the risk for below knee amputation by 15 to 40 fold. Development of these foot deformities have also been shown to reduce an individual’s ability to walk on their own and perform basic daily activities which results in a greater risk of depression, job loss and unemployment, early retirement, unemployment, disability claims and alcohol abuse. Almost half of those who develop a Charcot foot will have an early death.
Advice For Early Detection
So, how do YOU get your doctor to consider the potential that you have this condition? First, YOU MUST TAKE OFF YOUR SHOES and let the doctor see your feet. DO NOT wait to be asked. Doctors should be looking at your feet at every visit. You should also be checking your feet daily or having a loved one do this for you to catch any early signs that something may be different with your foot.
You and your doctor should be most concerned if all of these apply to you:
- You have loss of the ability to feel to your legs and feet for ANY reason
- You are 40 or older and have Type 1 diabetes
- You are 50 or older and have Type 2 diabetes
- You have been diagnosed with Type 1 or Type 2 diabetes for 10 or more years
- You are obese
- You have a hemoglobin A1c of 9% or more
- You have little to no foot pain
- You cannot remember or did not do something to cause pain or swelling of your foot
- One of your legs is red, hot and swollen and you do not have a wound on that leg or foot
Your doctor should know that:
- You will not have any signs of infection in blood tests if it is Charcot
- You often will not have a deep blood clot seen on an ultrasound exam
- Xrays taken of your foot may look normal apart from swelling. Your doctor should pay close attention to the middle area of the foot as this is the area most affected by Charcot.
- Even though an x-ray may look normal, an MRI or CAT scan will show changes to the bones being affected by Charcot
Given that more than half of primary care doctors don’t even really know about Charcot YOU need to inform them of the potential for this condition. Even if you end up not having Charcot yourself, you may help others by making your doctors aware. In the end you may save your own leg from amputation along with those of others.
Keep you eyes peeled for the next topic in this series: I’ve been diagnosed with Charcot. Now what?
The first article in this series can be found here.